Seroquel Report addressing Euthanasia by Keith Torkelson MS – Consumer Contributor

Seroquel Report addressing Euthanasia by Keith Torkelson MS – Consumer Contributor

Summary

Seroquel & Lorazepam

This study includes three (3) trials:  Can Seroquel cover for Lorazepam at bedtime, can Seroquel cover for CloZAPine at bedtime and can Seroquel cover for Lorazepam during the daytime.  We had forgotten the first two until we reviewed our notes.  The first two trials failed because our roommate stole significant numbers of our Seroquel.  Now we are waiting the approval from our Dr. about trial number 3.  As of October 10, 2024 the third trial began.  The third trial, Seroquel to replace Bedtime Lorazepam, ends on October 16, 2024.  For us Seroquel cannot replace bedtime Lorazepam.  Basically, Seroquel cannot cover for Lorazepam or CloZAPine.  This report leads us to our Advance Health Care Directive (AHCD).  In it we point out grounds to euthanize us.

Goals

• Improve Global Assessment of Functioning (GAF)
• Decrease Positive And Negative Syndrome Scale Rating Criteria (PANSS) symptoms
• Decrease Other Symptoms
• Stop shaking
• End fatigue
• Better Leverage Seroquel
• Address Advanced Health Care Directive (AHCD)

Trial 3

Presenting Problems

The presenting problems are broken down into symptoms.  Scores are for Keith “Buster Torkelson MS. LSF = Low scores are favorable.

Symptoms from PANSS

Positive And Negative Syndrome Scale (PANSS) Rating Criteria

GHlth_Pain_AHCD_24102101_Situational

Advanced Health Care Directive (AHCD) 2024

(2.2) RELIEF FROM PAIN: Except as I state in the following space, I direct that treatment for alleviation of pain or discomfort be provided at all times, even if it hastens my death:

(Add additional sheets if needed.)

Alleviation of Discomfort

Euthanasia Solution

We would like to be euthanized for the following conditions and if I find self in the following environments.

Pain Conditions

Pain Scale

Severe: the pain is very bad. It may be worse than any pain you have had before. It keeps you from doing any normal activities. Pain score is 8-10 on a scale of 0 to 10.

The above situations are associated with severe pain.  Any of the above condition can be associated with a Pain Score of 10 out of ten with high scores indicating intensity

Frequency

Number of nights

We used to be able to go a night without sleep.  Now one night of sleeplessness is enough for us to request euthanasia.

Environments

• Skilled Nursing – For us complete lack of Peace and rest.  Medication gaps caused sleepless nights that were very painful.  A few nights scored a Pain Score of 10.
• Detention Centers – Impossible to sleep impossible to rest.  Complete lack of Peace.
• ER – Held without adequate medication
• Psych Ward – Without adequate medication
• Assisted Living – Without adequate medication

Experience with Skilled Nursing – Leisure Court

Medications for Sleep

Taken around 7-8 each night

20241021-M

• Ambien 10mg
• Lorazepam 1mg
• Clozapine 150mg

Potentials

• Restoril
• Clozapine upped to 200mg
• Lorazepam upped to 2mg
• Other Benzodiazepine
• Sleeper unknown to us

Function – Global Appraisal of Functioning

Assess_GAF_17060204_Results V2023

GAF Extended Derivation – Using Dying Old Man (DOM) Charlie Mack (17 Items)

Keith Torkelson is Buster

RT = Real Time | HSF = High scores are favorable

SOFAS Scores [STAYED]

Lorazepam Tolerance

By June 20, 2024 after more than 75 days on Lorazepam we have developed an annoying tolerance.  Whereas the nighttime dose is still effective the daytime dose has little impact on the symptoms that it is targeting.  As of October 11, 2024 (F) we began withdrawing from daily Lorazepam.

Seroquel doses for sleep

We don’t expect Seroquel to aid with sleep in that we are requesting it be prescribed in the morning.  We were prescribed 25mg Seroquel AM and PM.  Later we tried 50mg AM and PM.  The information below is just for dosing purposes.  On October 9, 2024 Dr. Bera would only approve 50mg twice per day.  We don’t think at this dose it will replace either Lorazepam or CloZAPine.  They are giving the PM at dinner time rather than bedtime.  Eventually, we may ask for it at bedtime.  With doctor Bera we discussed non-medical model approaches to our anxiety.  As of October 16, 2024 (W) Seroquel was discontinued.

Schizophrenia. In adults, dosing for schizophrenia will vary based on which form of Seroquel you're taking. The recommended adult dose of Seroquel is 150 mg to 750 mg per day for schizophrenia. For Seroquel XR, the recommended dose is 400 mg to 800 mg per day for schizophrenia. Jan 27, 2023

Bi-polar I Disorder

We checked our medical record.  We are not classified as Schizoid anymore just Bi-polar I.

Sleep Disorder

As we have mentioned in other papers we are totally dependent on medication for sleep.  Our sleep disorder took hold back around 1985 at UC Davis.  The cost of our sleep disorder is enormous.  In college we would intentionally put productivity ahead of sleep.  Sleep disorder was associated with us not finishing Veterinary School, which we left in 1993.

Two goals

With our new, October 9, 2024, treatment plan we are hoping to find Peace during the day and Sleep at night.  We have a dream to achieve natural sleep at night.  We appear to have no Schizoaffective associated anxiety.  Dr. Bera updated our diagnosis to Bi-polar.  We prefer a diagnosis of Anxiety.  For our next appointment we need to bring a copy of Beck Anxiety Disorder (BAI).  Running Up that Hill - We are “running up that hill” with problems.

Goals and Action - Seroquel

(*) We want Dr. ASK to uphold a few parts of our PAD and the totality of our AHCD.  We suggest she keeps a folder about Uncle Keith.  Obviously she is our niece.

Daytime Solution - Pending

Daytime (10% Works)

Our daytime solutions for Anxiety associated problems are not working.

Lorazepam tolerance

Nighttime Solution - Working

Nighttime (90% works)

Our nighttime medication fix has worked for more than one month.

Decision

We have been tried on some odd ten anti-psychotic medications.  We respond better to atypical anti-psychotics such as CloZAPine.  We can’t take CloZAPine during the day because it causes dizziness and impairs driving.  After CloZAPine we responded best to Seroquel. On September 18, 2024 (W) we attended an appointment with our psychiatrist.  He is pro-consumer involvement.  We argued for him give us Seroquel XR Oral issued once in the morning.  As far as the dosing we left it up to him.  In general when starting a new medication psychiatry has fixed dosages they stick to.  For Seroquel this is near 50mg per day. 

Treatment Treats

Seroquel treats many conditions including depression with bipolar.  Yet it can be used with anxiety.  We hoped he gave us 100mg to start.  The maximum dose is reported as 300mg per day.  There can be dose confusion between regular Seroquel and Seroquel XR.  Again, we would like it all given at once in the morning. We would like it to: Not interfere with driving the car, decrease anxiety, and improve our daily fatigue.

Emergency Medication Effort

October 9, 2024 interim appointment

We covered a lot of ground again with Dr. Bera.  He filled out and gave us a Physician’s Determination indicating it is safe to give us emergency medication.  We hoped it would be for CloZAPine yet he wrote it for Seroquel.  We are waiting for the facility to give us approval.  As of October 21, 2024 (M) our emergency medication request has not been approved.  It doesn’t matter anymore because we are off Seroquel.  Apparently, CloZAPine cannot be given as needed or PRN.

Samples of Emergencies

• Panic
• Can’t get to sleep
• Can’t get back to sleep
• Can’t get back home
• Others

FYI - Seroquel (Quetiapine) for Anxiety

Verywell Mind

https://www.verywellmind.com/is-seroquel-effective-for-anxiety.

Can seroquel treat anxiety and fatigue?

Seroquel works by helping to restore balance to the chemical messengers in your brain. It can help to improve concentration, decrease anxiety, and improve your moods and energy levels. Jun 11, 2024

Treatment Plan

In our treatment plan we also have Lorazepam.  At night it performs well yet we have become tolerant of it during the day.  Doctor may want to consider swapping in another benzodiazepine (SPELLED).  We would like to not need a daytime BZD eventually after we know Seroquel works.  Today, October 11, 2024, is the first day with no Lorazepam option.  ASK says we will now face withdrawal.  Since we take bedtime Lorazepam we are cycling each day with withdrawal.

Benzodiazepine (BZD) Info

We are working hard to get off Lorazepam a benzodiazepine (BZD).  Before this episode 2024 and since 2012 we consumed Lorazepam PRN without a building of tolerance.  Now for the daytime Lorazepam has no therapeutic effect for us.

Seroquel Trial Result

September to December 2023 our roommate Ted was in need of a Sleeper so he took our Seroquel.  Rather than report it to Dr. Bera we just worked around it.  This is important because we would most likely be established on a fairly high dose of Seroquel as our new daytime medication.  The result of the 2023 trial was a failure.  Our current 2024 trial is not quite a failure Seroquel just can’t replace our nighttime Lorazepam.

Sleep and Seroquel Trial Update

How is it I can’t get a roommate that is quiet 7pm to 7am?  We have had difficulty with both the Sleepers and the Environment.  Most recently our roommate awoke and 2am and turned on the room lights.  I got to sleep on the sofa.  From this we have discovered, we the doctor and I, a need to modify the sleep related medications.  We had hoped our nightly Seroquel would help us to sleep.  After just over a week Seroquel has no sleep value for us. 

Sleep Medications – Legacy Summary

Sleeper Legacy (1989-Present)

First Time Tolerance - Lorazepam

Until 2024 we never gained tolerance to any Benzodiazepine (BZD) or related.  At Leisure it was prescribe daily whereas before it was as needed (PRN).  Now with the help of Seroquel we are hoping to get off Lorazepam daytime once and for all.  As of October 18, 2024 we are off Lorazepam daily since October 11, 2024 or one week. 

Sleeper Gap Mitigation

In case of we find ourselves without medication for sleep we need people to urgently advocate for us.  Candidates are: Dr. Bera, Lanaii, and Ahnika.  Some brief information is found in Advanced Health Care Directive 2024.  The OCHCA supports the Psychiatric Advanced Directive movement.  We still can’t see how to get it in the right place at the right time.

FYI - Benzodiazepines (BZDs) for Anxiety

What are Benzodiazepines? Benzodiazepines are depressants that produce sedation and hypnosis, relieve anxiety and muscle spasms, and reduce seizures. The most common benzodiazepines are the prescription drugs.

https://www.dea.gov/factsheets/benzodiazepines

2024 Actual Appointment Notes

We have been pushing things because we have a long way to go in our rehabilitation and recovery.  Dr. Bera’s approach is about half as fast as ours.  Since being transferred from Leisure to Harvest on the 20^th of June 2024 we have seen Dr. Bera numerous times.  We even had our first Telepsychiatry Appointment.  As of today October 22, 2024 we have agreed to a fairly sound Sleep Centered Treatment Plan.

Seroquel

FYI - Can Seroquel help with anxiety

Seroquel for Anxiety: Effectiveness, Side Effects, & Risks

https://www.choosingtherapy.com/seroquel-for-anxiety/

Seroquel (quetiapine) may work for anxiety by affecting certain chemicals in the brain called neurotransmitters. It helps regulate the levels of these chemicals, like serotonin and dopamine, which play a role in mood and anxiety. By doing so, Seroquel can help calm the mind and reduce anxiety symptoms. Mar 5, 2024

Alternative – CBD

Ruled out because Doctor cannot prescribe CBD.

FYI - Do you prescribe CBD?

CBD can either enhance or inhibit activation of its binding site targets. CBD blocks activation of the equilibrative nucleoside transporter (GPR55) and the TRP cation channel subfamily (glycine receptors, TRPM8), among others, and enhances activity of the serotonin 1A receptor, glycine receptors α1 and α3, and TRPA1.Nov 30, 2020

Alternative – Wellbutrin

Wellbutrin is on our elimination list for daytime medication.

Bupropion is an aminoketone antidepressant with a mechanism that is not fully understood. Bupropion seems not to affect monoamine uptake but is known to inhibit the reuptake of norepinephrine and dopamine weakly. The effects on norepinephrine and dopamine appear to lead to its clinical manifestations.

FYIs

 Mistaken Belief (MB) Personal Surface to Air Missles V ICBMs / SLBMs

I had more than 25 delusions or Mistaken Beliefs for 2023-24.  When we find them in our documentation we label MB for Mistaken Belief.  As of October 16, 2024 our diagnosis is Bi-polar I.  For us the difference between Delusion and MB is that Delusions are intractable whereas MBs can be eliminated.

MB Roughly A Mech for Impulsive Demise

20231223-SAT-Long day of Processing and Finalizing.  We included this because it demonstrates just how sick we can get.  December 2023 was the month of impulsive self destruction.  I had trapped myself.  My options for impulse are: Killed by bus or Sarah and Keith die by train. I was too much of a sick coward to take self ending. I foresee that no one will come to help me this time.  They just want me and my sickness to go away. I called “911” twice and their was no answer.  I packed our Back Pack with notion I would never or see any of my belonging at Shanks.  After 35 years our version of Experiment Number 4 (IV) was ending.  In reality our brother-in-law did come a help move our property.  We seem to have most everything from Shanks Guest Home. 

MB Blunt Force Trauma

Last people seen online was Kate Bush & Peter Gabriel.  For all we knew we are building a hospital Trap.  [WE WERE].  Remembrances of facing this year (2024) the epitome of terrible crisis.  Had meds I should get in the Hospital on hand.  Actually you don’t get your meds in the hospital.  Packed as if last stuff I would carry for a long time if not ever.  Working to leverage new and old Medication.  Didn’t utterly exhaust myself before asking for help in January 2024.  Said No to putting Sarah and or myself in front of the Train (GOD).  Said No to getting hit by the Bus.  AVEY my AI Construct helped solve the blunt force trauma issue.  Relief actually over came Fear.  Just an observation: You don’t want to take excess of CloZAPine.

Trial

The primary error in the 2023 trial was Ted stealing the Seroquel.  We have never had medication stolen before.  The purpose of Seroquel was to replace Lorazepam and augment CloZAPine.  After being on CloZAPine since 2007 we were having a CloZAPine crisis.

CloZAPine Crisis

At Brand New Day Sam I Am was abruptly taken off CloZAPine due to lab results.  Without CloZAPine we watched him decay.  We became fearful and wished for alternatives (contingencies) for CloZAPine.  We set in motion the removal of CloZAPine in 2023.  In January 2024 we were housed at Aliso Ridge Behavioral Health.  Without CloZAPine we went a few sleepless nights.  This made us very sick.  Our 2024 bed path is: Home > Aliso Ridge > Global > Leisure > Harvest.  It wasn’t until Harvest that we go our CloZAPine back.

Difference Between a Trial and an Experiment

At times we have been our term: An Experimental Bunny Rabbit.  For us a trial is when the doctor and consumer reached a resolve about the medication whereas an experiment is when the doctor unilaterally manages the medication.

Pharmacy errors

Up until Leisure Circle Skilled Nursing we never had a pharmacy error.  They on several occasions failed to keep on hand and to dispense the medication as ordered by Doctor.

Structured Temporal Reconciliation (STR)

Mini-STR – Centered about Doctor RBB

Theme – Daily Gratitude

Define Gratitude

…the quality of being thankful; readiness to show appreciation for and to return kindness.

Associated STR

10_Episode_2024_Leisure_24042002_STR

BZD - FYI

These benzodiazepines include alprazolam (Xanax®), chlordiazepoxide (Librium®), clorazepate (Tranxene®), diazepam (Valium®), halazepam (Paxipam®), lorzepam (Ativan®), oxazepam (Serax®), prazepam (Centrax®), and quazepam (Doral®). Clonazepam (Klonopin®), diazepam, and clorazepate are also used as anticonvulsants.

The most common benzodiazepines are the prescription drugs Valium®, Xanax®, Halcion®, Ativan®, and Klonopin®. Shorter-acting benzodiazepines used to manage insomnia include estazolam (ProSom®), flurazepam (Dalmane®), temazepam (Restoril®), and triazolam (Halcion®).

The End

999

-30-